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Lic 701 2026
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- Click ‘Get Form’ to open the lic 701 in the editor.
- Begin with Part A, where a parent or guardian must provide consent. Fill in the child's name and birth date, followed by the name of the child care center and its operating hours.
- In Part A, ensure that the parent or guardian signs and dates the form to authorize the release of medical information.
- Proceed to Part B for the physician's report. The physician should complete this section by noting any health concerns such as allergies, vision issues, and developmental considerations.
- Fill out the immunization history section accurately, detailing each vaccine received along with corresponding dates.
- Lastly, review any TB risk factors present and have the physician sign and date at the bottom of Part B.
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